The geriatric gravida: multifetal pregnancy reduction (mfpr), donor eggs, and aggressive infertility treatments

OBJECTIVE: Rerem technologic advances and societal acceptance have dramatically increased the use of donor eggs (DE) for infertile couples using assisted reproductive technologies {ARTs). and have allowed mam older couples to use ARTs to achieve pregnancies. We sought to evaluate the changing pattern oi patienis referred fur MFPR as a result of DE and age factors from 1986-7/96. METHODS: Patients undergoing MFPR from I9S6-7/96 were included and calegori/ed by year groupings, age. and the use of DE. RESULTS: -179 patients underwent MFPR. Prior to 1994 onl\ 4 of 226 (1.8%) used DE whereas in 94/96 25 of 253 (9.9%) used DE (X2 = 13.81: p = 0.0002) Six out of seven patients age 45+ undergoing MFPR used DK. There were no patients 45+ prior to 1994 but 9 in 94-96. Four of 9 patients age 45+ chose reduction to a singleton. The percentages of patients 40 + has increased from 5% to 109t in the last two and a half years. CONCLUSIONS: The availability of DE bas dramatically increased the use of ARTs and subsequent utiliJ.ation of MFPR in older patients. Older patients are more inclined to want to reduce to a singleton, and ihev site parental demands, financial issues, and their ability to parent in their 60s and 70s as reasons for reduction to a singleton. The emergence of large numbers of older gravidas will test assumptions about perinatal outcome, and will help define the number of MFPR to singleton as compared to twins as the usual stopping number.